CONRADIP.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92247
COMMUNITY SAFETY DIVISION
HOME OCCUPATION PERMIT
Permit Number: 13-00000155
(760)777-7050
FAX (760) 777-7011
Please read each condition listed on the attachment in this packet to see if the proposed activity complies
with the City's Home Occupation Regulations.
Applicant name(s): (List all owners, partners, and/or corporation officers) JERRY CONRADI
Property address: 78815 SUNBROOK LN Phone: (760) 578-1103
Mailing address: P.O. BOX 7371
Property owner: JERRY CONRADI
Type of business: Pool Service
Brief description of how the business will operate:
Square footage of usable floor area in house (exclude garage) 1700 square feet,
Location and square footage of area of business activity in home (Example: Bedroom –125 sq ft.) home
officeibedroom, 100 square feet
Description of machinery, equipment, and supplies being used in the business operation:
I HAV!READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A HOME
OCCIJP�,TION IS ALLOWED. (Conditions Attached) _
NT SIGN
DATE
is other than the property owner, authorization of owner or rental/leasing agent is required.
Your inspection has been scheduled for Home Occupation Inspection between 10:00-10:30 on 2/15/13. Your
inspector will be Moises Rodarte.
-------------------------- INSP US L ------------------------ 2-
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.0
APPROVED
O DENIED ns ector Signature Da e
CE HP
FEE $70.00
Tait
P.O. Box 1504
78-495 CALLS TAmplco (760) 177_7000
LA QWNTA, -CALIFORNIA 92253 'FAX (760) 777_7101
APPLICATION FOR HOME OCCUPATION OF A BUSINESS
INSPECTION DATE:.
Please read each condition listed on the attachment in this packet to see if the,.proposed
activity complies with the City's Home Occupation Regulations. -'
APPLICANT NAMES: in A owners, partners, and/or c mpora>ion officers
PROPERTY ADDRESS:
MAILING ADDRESS:
PROPERTY OWNER
PHONE:L�D
DMFERENTFROM ABOVE)
TYPE OF RESIDENCE, (SINGLE, MULTIPLE, MOBILE HOME, ETC.):
TYPE OF BUSINESS: _ Pon 1 Ie r- f
• BRIEF DESCRIPTIO SOF HOW THE BUSINESS WILL OPERATE:
NUAMER OF PERSONS INVOLVED IN BUSINESS:
SQUARE FOOTAGE OF USABLE FLOOR AREA IN HOUSE (EXCLUDE GARAGE):
LOCATION W SQUARE FOOTAGE OF A REA* OF BUSINESS ACTIVITY 1N HOME (EX_ BEDROOM -. .
- . - 125 SQ FT.): nI1`oA rte.. (W
DESCRIPTION OF MACHINERY, EQUIPMENT, AND SUPPLIES BEING USED IN THE BUSINESS
-QPERATION:
I HAVE READ, UNDERSTAND, AND AGREE WITH THE CONDITIONS BY WHICH A
OCCUPATION IS ALLOWED. (CONDITIONS ATTACHED)..-
. a Z- ! �/- 1 -3 -
[CANT'S SIGNATURE DATE
PLICANT IS OTHER THAN THE PROPERTY OWNER, AUTHORIZATION OF OWNER OR
ALILEASING AGENT IS REQUIRED.
. WORKERS COWENSAUON
If your company has employees, a copy of the Workman's Compensation Policy must accompany the•business
license application, indicating dates of coverage and dollar amount This proof of ooverage must be received
before the business license can be processed.
If yon do not have employees, please check the last section on this page: "I Certif that.....
If your business is being operated from your home in J Qmnta, a Rome Occupation Permit is required befte a.
business license is issued.
If you have any questions, -please contact the Code Compliance Division at 777-7050.
Every employer who applies for any license or renewal of any license for a business issued pursuant to Section
37101 of the government Code or Section 7284 of the Revenue and Taxation codeshalt complete end sign a
declaration that states the following:
I hereby affirm tinder penalty of perjury, one of the following declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided by Section 3700 for the duration of any business activities.
conducted for which this license Is issued.
• I have and will maintain Worker's Compensation Insurance, as required by Section
3700 for the duration of any business activities conducted for which this license is
issued
My Worker's Compensation insurance carrier and policy number:
Carrier .
Policy Number. Expires:
A COPY OF SAID POLICY OR CERTIFICATE OF CONSENT SHOWING THE AMOUNT OF
COVERAGE AND EXPIRATION DATE FOR WORKER'S COMPENSATION IS REQUIRED TO
PROCESS THIS LICATION.
I
oeridy that in the performance of any business activities for which this license is
issued, I shall not employ any person in any manner so as to become subject to the
workea's compensation laws of California, and agree that if I should become subject to
the worker's compensation provisions of Section 3700, I will provide the City with a
policy or certificate copy within ten (I0) days of the change in requiiements.
APPLICANT SIGNATURE DATE
ARNING. Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer
criminal penatties'and civil fine§ up to 5100,000. In addition to the cost of compensation, damages,
*rest, and attorney's fees may be assessed to you as provided in Section 3706 of the Labor Code.
C
PLEASE READ!
Please contact your Homeowner's Association prior to pa, ' or your Home
Occupation Permit. Your Homeowner's Association may trict or prohibit
home based businesses.
I. HAVE AND UNDERSTAND THIS
-STATEME
•
KI
OWNER/AGENT SIGNATURE DATE
AGENT COMPANY NAME CONTACT PR .#
Il"ORTANT: FALSE OR AUSLEADING INFORMATION BL GROUNDS FOR DENYING
YOUR HOME OCCUPATION; FAILURE TO COMPLY CONDITIONS LISTED ON THE
ATTACHED PAGE SHALL BE GROUNDS FOR REVOCA _ N OF PERMI�'
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BUILDING AND SAFETY. DEPARTNNIENIYCODE LIANCE DIVISION:
APPROVED DENIED SPECIAL CONDITIONS
OFFICER I.D. DATE